When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Rheumatic fever

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Последний просмотренный: 20 Aug 2025
Last updated: 10 Apr 2024

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • fever
  • joint pain
Полная информация

Другие диагностические факторы

  • recent sore throat or scarlet fever
  • recent skin infection
  • chest pain
  • shortness of breath
  • palpitations
  • heart murmur
  • pericardial rub
  • signs of cardiac failure
  • swollen joints
  • restlessness
  • clumsiness
  • emotional lability and personality changes
  • jerky, uncoordinated choreiform movements
  • inability to maintain protrusion of the tongue
  • milkmaid's grip
  • spooning sign
  • pronator sign
  • erythema marginatum
  • subcutaneous nodules
  • pregnancy or taking oral contraceptive pill
Полная информация

Факторы риска

  • poverty
  • overcrowded living quarters
  • family history of rheumatic fever
  • HLA association
  • genetic susceptibility
  • indigenous populations; Aboriginal Australian, Asian, and Pacific Islanders
  • D8/17 B cell antigen positivity
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • erythrocyte sedimentation rate (ESR)
  • CRP
  • WBC count
  • blood cultures
  • electrocardiogram
  • chest x-ray
  • echocardiogram
  • throat culture
  • rapid antigen test for group A streptococci
  • anti-streptococcal serology
  • rapid molecular test
Полная информация

Алгоритм лечения

Начальные

monoarthritis in unconfirmed rheumatic fever

Острый

possible rheumatic fever

confirmed rheumatic fever

ПРОДОЛЖЕНИЕ

all patients following acute treatment

Составители

Авторы

Liesl Zühlke, MBChB DCH FCPaeds Cert Card (Paeds) MPH FACC FESC MSc PhD

Vice-President South African Medical Research Council - Extramural Research and Internal Portfolio

Director Children's Heart Disease Research Unit

Paediatric Cardiologist, Division of Paediatric Cardiology, Department of Paediatrics

Red Cross Children's Hospital

Cape Heart Institute and Institute of Infectious Diseases and Molecular Medicine

Faculty of Health Sciences

University of Cape Town

Cape Town

South Africa

Раскрытие информации

LZ has been funded by the South African Medical Research Council, NRF, and through the African Research Leader award jointly by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. LZ is a board member of the World Heart Federation, the NCD Alliance, and FoodForward South Africa. LZ an author of the UpToDate rheumatic heart disease topic. None of the above are competing interests.

John Lawrenson, null

Head of Clinical Unit

Paediatric Cardiology Service of the Western Cape

Red Cross Children's and Tygerberg Hospital

Stellenbosch University and University of Cape Town

Cape Town

South Africa

Раскрытие информации

JL declares that he has no competing interests.

Выражение благодарностей

Professor Liesl Zühlke and Professor John Lawrenson would like to gratefully acknowledge Dr Rachel Webb, Dr Andrew C. Steer, and Dr Jonathan Carapetis, previous contributors to this topic.

Раскрытие информации

RW declares that she has no competing interests; she is an active researcher and clinician in acute rheumatic fever/rheumatic heart disease and is a co-investigator on a (non-industry) grant funded by the Health Research Council of New Zealand and gives educational talks and has prepared manuscripts on rheumatic fever solely in capacity as a University of Auckland academic and Paediatric Infectious Diseases Specialist. ACS and JC declare that they have no competing interests.

Рецензенты

Salah Zaher, MD

Professor of Pediatrics

Division of Pediatric Cardiology

Faculty of Medicine

University of Alexandria

Cardiologist

El Shatby Children's Hospital

Alexandria

Egypt

Раскрытие информации

SZ declares that she has no competing interests.

Nigel Wilson, FRACP

Paediatric Cardiologist/Interventional Cardiologist

Paediatric and Congenital Cardiac Services

Green Lane Clinical Services

Starship Children's Hospital

Auckland

New Zealand

Раскрытие информации

NW declares that he has no competing interests.

Andrea Summer, MD

Assistant Professor of Pediatrics

Medical University of South Carolina

Charleston

SC

Раскрытие информации

AS declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO Expert Consultation. 2004 [internet publication].Полный текст

Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015 May 19;131(20):1806-18.Полный текст  Аннотация

Carapetis JR, Beaton A, Cunningham MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. 2016 Jan 14;2:15084.Полный текст  Аннотация

Denny F, Wannamaker LW, Brink WR, et al. Prevention of rheumatic fever; treatment of preceding streptococci infection. J Am Med Assoc. 1950 May 13;143(2):151-3. Аннотация

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009 Mar 24;119(11):1541-51.Полный текст  Аннотация

RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022). 2022 [internet publication].Полный текст

Heart Foundation of New Zealand. New Zealand guidelines for rheumatic fever: diagnosis, management and secondary prevention of acute rheumatic fever and rheumatic heart disease: 2014 update. 2014 [internet publication].Полный текст

Manyemba J, Mayosi BM. Penicillin for secondary prevention of rheumatic fever. Cochrane Database Syst Rev. 2002;(3):CD002227.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Использование этого контента попадает под действие нашего заявления об отказе от ответственности